Pediatric Urology

pediatric urologyPediatric Urology Overview:
The pediatric urology services at Stony Brook treat congenital abnormalities of the genitourinary system in children.  As a regional leader, Stony Brook is the only hospital in Suffolk County to offer advanced pediatric urologic procedures such as hypospadias repair surgery, complex reconstructivesurgery, and minimally invasive robotic surgery.

Pediatric Urology Conditions:

 

Antenatal Hydronephrosis

HydronephrosisOverview
Antenatal Hydronephrosis is a condition that occurs during pregnancy, when a baby is in the mother’s womb. In hydronephrosis, the baby’s kidneys collect too much urine, resulting in swelling of the kidneys. The condition is not serious and has no long term complications.

Symptoms

Antenatal Hydronephrosis does not cause any symptoms. A doctor will find out a baby has hydronephrosis during an ultrasound.

Treatments we offer

During Pregnancy: Doctors will follow the condition, but usually do not treat it.

After Pregnancy: If hydronephrosis went away before birth, then your baby will not need any testing.

If hydronephrosis did not go away after pregnancy, additional testing will be needed based on the table below:

SeverityUltrasound is performed...Medication
Only one kidney / MildAfter 1 weekAntibiotics
Both kidneys / SevereFirst few days of lifeAntibiotics

Circumcision

Overview
Circumcision is a commonly performed procedure in the newborn period, most often done by the obstetrician before discharge from hospital. However, many newborns may go uncircumcised for a variety of reasons - newborn illness, prematurity or voluntarily by parental choice. Although circumcision need not routinely be done (a position held by the American Academy of Pediatrics), the parents may opt for circumcision subsequent to the newborn being discharged from the hospital. The advantages and disadvantages of circumcision may be discussed, and a rational decision reached regarding the very need for this procedure.

Advantages and Disadvantages

AdvantagesDisadvantages
  • Lower risk of urinary tract infection in children
  • Lower risk of sexual transmitted diseases
  • Lowers risk of penile cancer
  • Prevents phimosis
  • The area can get irritated from contact with diaper
  • Risk of bleeding
  • Decrease in sensation of penis
  • Damage / irritation to the opening of penis

Proper care after a circumcision

It is important that the proper care is taken for the first 2 weeks after circumcision. Please be aware of the following guidelines post-circumcision:

  • Use a gauze pad with petroleum jelly or an antiobitoic cream
  • There may be blood at first (this is normal)
  • Keep the penis clean with soap and water
  • The area may appear to be red or raw

Helpful resources on Circumcision:

Incomplete Circumcision

Overview
Circumcision in a male is the surgical removal of the foreskin on the penis. In some cases, too little skin is removed and the penis appears to have not been circumcised or looks asymmetric. Less comonly, the head of the penis may still remain covered and unable to be exposed (hidden penis). 

When to see a doctor
Icomplete circumcision is best accomplished via ambulatory or same day surgery under general anesthesia between six months and one year of age. This allows an appropriate amount of foreskin to be removed and offers the best functional and cosmetic result in a pain-free fashion. See a pediatric urologist to determine if the circumcision needs revision and to weigh out the risks of reoperation against the benefits of improved cosmetic appearance.

Dysuria

Overview
Dysuria is decribed as painful urination, and is associated with a frequent and urgent need to urinate.

Types of Dysuria

  • Pain at the initiation of urination (associated with the urethra)
  • Pain at the end of urination (associated with the bladder)

When to see a doctor

Visit a doctor if your child is complaining about painful urination or if crying associated with a wet diaper. Dysuria has common symptoms with many infectious and noninfectious conditions; a pediatric urologist will be able to determine the root cause of the pain and rule out other conditions.

Treatments we offer

  • Antibiotics

Hydrocele

Overview
A hydrocele is when fluid builds up inside of the scrotum. This condition is common in newborn boys, and typically goes away by time the baby reaches 1 year old.

Symptoms

A hydrocele does not typically cause any symptoms; however, if it gets large enough you may experience the following:

  • Pain / discomfort in the scrotum
  • Swelling / irritation in the scrotum
  • The scrotum feels heavy

When to see a doctor

See a doctor if you are experiencing any of the above coniditions. Your doctor will properly diagnose the condition with the use of a light test or ultrasound.

Treatments we offer

A hydrocele is not always treated. Sometimes a hydrocele will go away on it's own. If your baby's hydrocele has not gone away by age 1, then it will likely need surgery to drain the fluid.

Hypospadias

HypospadiasOverview
Hypospadias is a type of birth defect the affects the penis. Boys born with this birth defect have an urethral opening (the hole that urine comes out of) form in the wrong place. The opening may form close to the tip, along the shaft of the penis, or close to the testicles.

Symptoms

  • Urine will flow in an unusual direction
  • Harms the ability to get a woman pregnant

When to see a doctor

A healthcare team will most likely find this defect during an examination after birth. The doctor will sometimes do a blood test to determine if the defect is hormone or gene related.

Treatments we offer

  • Treatment is not always needed in mild cases (urine will stream in slightly different direction)
  • Surgery to create a new urethra opening (when the boy is 6 months old)
    • More than 1 surgery may be required
    • It is a good idea to hold off on circumcision (surgeon can use the skin that is normally removed)

Meatal Stenosis

Overview
Meatal Stenosis is when the opening at the end of the penis (external urethra meatus) becomes narrow due to irritation (ex: rubbing against a wet diaper). Stenosis is more commonly seen in boys between 3-7 years old that are circumcised, and is rare in uncircumcised boys.

Symptoms

  • Narrow / upward urine stream
  • Difficulty directing urine stream
  • Painful urination

When to see a doctor

Visit a doctor if your child is experiencing any of the above symptoms and has recently become circumcised or freqeuntly exposed to a wet diaper.

Treatments we offer

  • Meatotomy
    • Goal is to enlarge the opening by cutting the skin that covers the meatus
    • Procedure takes 15-30 minutes and takes 1-2 days to recover

Helpful resources on Meatal Stenosis:

Nuerogenic Bladder

Overview
Neurogenic bladder refers to when the bladder does not function properly because of nerve damage. It is usually caused from a spinal cord injury or spina bifida.

Symptoms

  • Urine leakage - not having control over urine coming out
  • Urine retention - having trouble releasing urine
  • Urinary tract infection (UTI) that causes pain

When to see a doctor

See a pediatric urologist if your child is having any of the above symptoms. A physical exam will be performed, and your child may have a urine test, urodynamic study, or ultrasound to determine a proper diagnosis.

Treatments we offer

  • Bladder retraining - having scheduled times for using the bathroom
  • Using a catheter to empty the bladder during the day
  • Medicine - to relax the bladder or reduce chance of infection
  • Artificial sphincter - a small cuff around the neck of the bladder that can be used to inflate or deflate the bladder

Nocturnal Enuresis (Bedwetting)

Overview
Nocturnal enuresis is the medical term for bedwetting, which is a common childhood problem. Typically, by age 4 children learn to control their bladder during the daytime. Nighttime bladder control takes slightly longer to learn; usually when the child is 5 to 7 years old.

Causes

  • Child’s bladder is maturing slowly
  • Child’s bladder holds a smaller amount of urine
  • Diminished level of vasopressin (hormone that reduces urine production)

When to see a doctor
Visit a doctor if your child has:

  • To urinate frequently / urgently
  • Extreme thirst during the day
  • Constant bedwetting after weeks or months of being dry

Treatments we offer

  • Education and motivational therapy (Primary)
  • Education and motivational therapy (Primary)
  • Medications - Desmopressin is a medication to reduce the amount of urine during sleep (Tertiary)

Phimosis

Overview
Phimosis refers to tight foreskin that cannot be retracted, and as a result the glans of the penis cannot be exposed. This condition is normal in uncircumcised infant / children, and typically resolves after 5-7 years. When young children have phimosis, it is either normal or physiologic.

Symptoms

  • Appears as a tight ring of foreskin around the tip of the penis
  • Cannot fully retract foreskin

Treatments we offer

  • Gentle manual retraction of foreskin
  • Topical corticosteroid ointment - used to soften the foreskin
  • Circumcision - surgical removal of the foreskin

Undescended Testis

Overview
Just before the birth of a boy, the testes move down into the scrotum. In some cases, one or both of the testes stop short during their descent into the scrotum and remain in the abdominal cavity.

Symptoms Undescended testes does not cause any symptoms. A doctor will find the problem during an examination shortly after birth. This problem is seen more frequently in premature babies.

Treatments we offer

In most cases, no treatment is needed and the testicle or testicles will descend to the scrotum after a few months.

If the testes do not descend on their own then surgery will be performed to move them to the scrotum. Surgery can be completed as soon as 4 months after birth, and no later than 2 years of age.

Ureteropelvic Junction Obstruction (UPJ)

Overview
Ureteropelvic junction (UPJ) obstruction is a partial or complete blockage of urine flow that occurs where the ureter enters the kidney.

Symptoms

  • Abdominal mass
  • Urinary tract infection (UTI)
  • Kidney stones

When to see a doctor

Most cases will detected during a prenatal ultrasound screening, and will need further imaging to differentiate between UPJ obstruction and antenatal hydronephrosis.

Visit a doctor if your child is older and experiencing the above symptoms to receive an examination.

Treatments we offer

Treatment may not always be necessary. Poor drainage may only be temporary in children younger than 18 months.

Older children may need the following treatment methods:

  • Robotic-assisted laparoscopic pyeloplasty - Using a surgical robot to remove the UPJ and reattach the ureter to the renal pelvis
  • Internal incision - Inserting a wire through the ureter to cut the tight and narrow UPJ. A special ureter drain will be left in for a few weeks.

Helpful Resources on UPJ Obstruction:

Ureterocele

Overview
A ureterocele is when the end of the ureter that enters the bladder does not properly develop. With this birth defect, the end of the ureter begins to swell and can stop the flow of urine to the bladder.

Symptoms

  • Side, back, or abdominal pain
  • Urinary tract infection (UTI)
  • Painful urination

When to see a doctor

In most cases, a ureterocele can be detected during a maternal ultrasound before before the birth of a child. However, a ureterocele may not be diagnosed until the child is seen for another problem, such as an UTI.

Treatments we offer

  • Transurethral puncture - Puncturing and decompressing the ureterocele with the use of a cystoscope (Usually takes 15-30 minutes)
  • Removal of the Ureterocele - Surgical removal of the ureterocele and rebuilding of the ureteral flap valve
  • Ureteropyelostomy - Connecting the obstructed and non-obstructed part of the ureter
  • Antibiotics - Used to fight against / prevent kidney infection

Helpful Resources on Ureterocele:

Varicocele

Overview
A varicocele is a group of swollen veins located inside the scrotum. Boys can experience varicoceles at any age. Varicoceles may be a factor in men having trouble getting a woman pregnant.

varicoceleSymptoms

Varicoceles typically do not cause any pain or symptoms; however, your child may experience the following:

  • Dull ache in the testicle
  • Swelling in one testicle (more common on the left side)
  • Testicles look different sizes

When to see a doctor

Visit a doctor if you are experiencing the symptoms listed above. Your doctor will most likely be able to diagnose a varicocele by an examination.

Treatments we offer

    • Pain medicine - Ibuprofen can relieve discomfort
    • Wearing tight underwear to support the scrotum
    • Surgery to stop the blood flowing into the swollen veins

Helpful Resources on Varicoceles:

Vesicoureteral Reflux (VUR)

Overview

Vesicoureteral reflux causes the urine to flow in the wrong direction inside of the body.
Normally, the flow of urine goes from the: kidneys → ureter → bladder
The flow of urine in patients with vesicoureteral reflux is: bladder → ureter → kidney

Symptoms

There are no symptoms seen with vesicoureteral reflux.
A doctor usually believes a child has it if they have one of the following conditions:

  • Hydronephrosis (swelling of the kidneys)
  • Urinary Tract Infection (UTI)

Treatments we offer

  • Antibiotics - to prevent a UTI
  • Surgery - to stop the backflow of urine from the bladder to kidney

Physicians

wasnickyoung
Robert J. Wasnick, MD, FAAP, FACS
Professor
Pediatric Urology
Ezekiel Young, MD
Assistant Professor
Pediatric Urology